Smoking Interventions for Hospital Patients: A Comparative Effectiveness Trial Project Summary/Abstract The Challenge: This application addresses broad Challenge Area (04), Clinical Research, and specific Challenge Topic, 04-HL-116: Cost-effective strategies to achieve smoking cessation in hospitalized patients with cardiovascular disease and COPD. Cigarette smoking is the leading preventable cause of death in the U.S. The 2008 U.S. Public Health Service Smoking Cessation Guideline recommends offering effective treatment to smokers in every health care setting. A hospital admission provides an opportunity for a smoker to quit. Smoking cessation counseling provided in the hospital is effective, but only if it continues for >1 month after discharge. Smoking cessation medications add benefit to counseling but are not often used. The current challenge is to translate this efficacy research into routine clinical practice. The major barrier is to make the transition from inpatient to outpatient care. National Hospital Quality Measures (NHQM) now report whether a tobacco intervention is provided to hospitalized smokers with CVD, COPD, or pneumonia, but the necessary post-discharge contact is not required. An evidence-based, cost-effective intervention model that can be adopted by U.S. hospitals is needed to realize the potential impact of hospital smoking interventions. Research Plan: The Specific Aim is to conduct a randomized controlled comparative effectiveness trial of two strategies to promote smoking cessation in hospitalized patients: (1) a hospital-only intervention that meets NHQM quality standards ("Standard Care"), and (2) an "Enhanced Care" model that will facilitate the sustained use of smoking counseling and medication after discharge to produce long-term abstinence. It will include 3 months of telephone counseling after discharge and feature 2 innovations. First, to increase medication use, smokers willing to make a quit attempt will receive a free 30-day sample of their choice of FDA-approved smoking cessation medication at hospital discharge. Second, to increase counseling cost-effectiveness, we will use interactive voice recognition (IVR) technology. It will make automated telephone calls to identify the smokers most likely to benefit from continued counseling after discharge. The trial will enroll 330 adult smokers admitted to Massachusetts General Hospital, a 900-bed teaching hospital. Outcomes will be measured 1 and 6 months after hospital discharge. Study hypotheses are that the enhanced care arm, compared to usual care, is feasible and will increase (1) the use of smoking cessation treatment after discharge, (2) the duration of post-discharge tobacco abstinence, and (3) validated tobacco abstinence 6 months after hospital discharge (primary outcome). The cost-effectiveness (cost per quit) of the interventions will be also be compared. Potential Impact: Nearly 4 million U.S. smokers are hospitalized each year, many of them at high risk for tobacco-related mortality due to CVD or COPD. This project could identify a way to translate an effective smoking cessation intervention into routine hospital practice and thereby increase the reach and impact of tobacco treatment. It could also provide evidence to support a revised NHQM hospital quality measure. Project Relevance Cigarette smoking is the leading preventable cause of death in the U.S. Smoking cessation reduces health risks. Being hospitalized provides a smoker a good opportunity to quit smoking. This project will test two strategies for providing assistance, using both smoking cessation counseling and pharmacotherapy, to help hospitalized smokers stop smoking after hospital discharge.